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The Finnish emergency medical services dispatch protocol is suboptimal, with frequent over-triage of high-priority calls and under-triage of low-priority calls, impacting patient outcomes.

Keywords:
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Area of Science:

  • Emergency Medicine
  • Healthcare Systems Analysis
  • Clinical Triage Protocols

Background:

  • Finland utilizes a four-tiered dispatch protocol (A-D) for emergency medical services (EMS) calls, managed by non-medical personnel.
  • Potential discrepancies in triage accuracy can lead to inefficient EMS resource allocation and adverse patient outcomes.
  • This study aimed to evaluate the accuracy of the national dispatch protocol by comparing initial triage with on-scene assessments.

Purpose of the Study:

  • To assess the accuracy of the Finnish emergency medical services dispatch protocol.
  • To evaluate the association between the initial dispatch priority and the patient's condition determined by on-scene EMS assessment.
  • To identify potential over- or under-triage within the existing protocol.

Main Methods:

  • A prospective cohort study involving 12,729 EMS missions in Northern Finland from January to June 2014.
  • Clinical variables were collected from medical charts for each mission.
  • Patient risk was re-categorized using the National Early Warning Score (NEWS) based on on-scene clinical data.

Main Results:

  • Overall, 67.5% of dispatch missions were correctly estimated according to NEWS.
  • A significant proportion of high-priority missions (A and B) were overestimated (76.9% and 78.3%, respectively).
  • 10.7% of low-urgency missions (C and D) were underestimated, with 32.0% of high-risk NEWS patients initially classified as low urgency.

Conclusions:

  • The current Finnish medical dispatch protocol requires improvement due to suboptimal accuracy.
  • The protocol demonstrates a tendency towards over-triage for high-priority calls.
  • There is considerable under-triage of high-risk patients who are initially assigned lower dispatch priorities.